Seth’s blog

I previously blogged about ICU checklists. Atul Gawande has written another excellent article about them, this time an editorial in the New York Times:

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government’s decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. . . . A checklist may require even more stringent oversight [than drug tests], the [OHRP] ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures. . . .

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It’s not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization.

Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger. . . . Scientific research regulations had previously exempted efforts to improve medical quality and public health — because they hadn’t been scientific. Now that the work is becoming more systematic (and effective), the authorities have stepped in. And they’re in danger of putting ethics bureaucracy in the way of actual ethical medical care.

Not “in danger of” — they have put “ethics bureaucracy” ahead of patient safety. In a big way.

From Until Proven Innocent by Stuart Taylor and K. C. Johnson, about the Duke lacrosse case:

The Duke president addressed the [lacrosse] team for the first time since May a few weeks into its fall practice. . . . When Brodhead opened the floor for questions, Read Seligmann’s former roommate, Jay Jennison, spoke up. He said that all of the team had learned much from the case . . . “What have you and the administration learned?” Jennison asked Brodhead. . . . Brodhead responded, “What do you think I should have learned?”

Head of a prestigious institution of higher learning resistant to learning or at least admission of learning. Curious.

Tulane University.

A few weeks ago, the manager of a New Orleans art gallery told me a story that I wish had surprised me.

When he was a senior at Tulane University, he took a Political Science class about the British Political System. For his term paper he wrote about the functions of the British Cabinet. The night before the final he got a phone call. It was from the Tulane honor board: He was charged with plagiarism. He was devastated, and did badly on the final.

The next semester a hearing took place. At the hearing, he listened to a tape of his professor’s testimony. The professor recommended that he be expelled: Not only had he plagiarized, the professor said, he had flunked the final. The supposed plagiarism was that he had listed ten functions of the British Cabinet without giving a source. He had believed that this was common knowledge, such as saying the sky is blue, and thus did not need a source. He had not copied word for word — he had paraphrased his source. The honor board gave him an WF for the course — withdrawal with an F.

The charge of plagiarism is absurd. It isn’t even obvious that the student did anything wrong — he is correct that you don’t need to reference “the sky is blue.” The telling part of this story is not that an individual professor was cruel and stupid — it is that a committee of professors backed him up.

Another case — this time at Memorial University of Newfoundland — where a committee of professors did exactly the wrong thing with awful consequences for an innocent person. The current Memorial administration now defends this!

A website about how IRBs (institutional review boards) abuse their power. IRBs are university-wide committees that oversee research. They consist mostly of professors.

So you can see why I wasn’t really surprised.